Background-Atrial fibrillation (AF) often occurs after coronary artery bypass grafting and can result in increased morbidity and mortality. In the present pilot study, our aim was to investigate whether sodium nitroprusside (SNP), as a nitric oxide donor, can reduce the frequency of post-coronary artery bypass grafting AF. Methods and Results-To investigate the effectiveness of SNP in the prophylaxis of AF, we conducted a prospective, randomized, placebo-controlled clinical study on 100 consecutive patients in whom we performed elective and initial CABG operations. A control group of 50 patients were treated with placebo (dextrose 5% in water), whereas the SNP group (nϭ50 patients) was treated with SNP (0.5 g · kg Ϫ1 · min Ϫ1 ) during the rewarming period. High-sensitivity C-reactive protein levels were measured before surgery and 5 days postoperatively. All patients were monitored postoperatively with telemetry. Baseline characteristics were similar in both treatment groups. AF occurred in 12% of the SNP group and 27% of the control group. The occurrence of AF was significantly lower in the SNP group (Pϭ0.005). The duration of AF in the SNP group was significantly shorter than that in the control group (5.33Ϯ1.86 and 7.55Ϯ1.94 hours, respectively; Pϭ0.023). C-reactive protein levels were higher postoperatively in the control group than in the SNP group (PϽ0.05). Postoperative AF significantly prolonged postoperative hospital stay (PϽ0.05). Conclusions-The

SNP administration during rewarming period of non-pulsatile CPB in patients undergoing CABG surgery is associated with improved renal function compared with conventional medical treatment providing adequate preload and mean arterial pressures.

BackgroundAlthough off-pump coronary artery bypass (OPCAB) surgery has many beneficial effects compared with on-pump surgery, switch to on-pump surgery has significantly higher risks of operative mortality. Benefits of OPCAB over on-pump surgery strategies concerning myocardial revascularization are still debatable. We have aimed to develop an "algorithm of off-pump surgical strategy" on preventing conversion to on-pump. This clinical study reports our clinical outcome of OPCAB in patients with acute coronary syndrome.MethodsBetween January 2006 and December 2008, 198 patients with acute coronary syndrome were enrolled in the study. Decision of OPCAB (142 patients) or on-pump surgery (56 patients) was made according to patients' present clinical status and our surgical background. Cardiac enzymes, duration of the surgery, graft numbers, stay in intensive care unit were recorded.ResultsOPCAP group has shorter operation time (82.78 min versus 164.22 min, p < 0.001), lesser necessity for intra-aortic balloon pumping (3.5% versus 12.5%, p = 0.053), shorter duration of intensive care unit stay (p < 0.05) and hospital stay (p < 0.001) compared to on-pump patients. EuroSCORE level was lower in OPCAP group (p < 0.001). None of the patients of OPCAB group required conversion to on-pump technique.ConclusionsThe patients who admitted to the hospital with acute coronary syndrome within "golden hours" (within 6 hours after onset) had a greater chance for OPCAB surgery. This study proves that EuroSCORE is likely to be an important factor in deciding which surgical technique to use, but a further investigation is needed to verify. According to our findings, a careful evaluation of coronary angiography, hemodynamic status, quality of target coronary vessel and timing of surgery are important for OPCAB surgery to avoid conversion to on-pump. By a careful systematic evaluation of the patients as explained with this article, it can be prevent or reduce conversion to on-pump surgery during OPCAB surgery.

Off-pump CABG can be done with an acceptable mortality and clinic results in patients who have ventricular dysfunction.

We describe a case of 68-year-old woman which was admitted to our hospital for mitral valve replacement (MVR), in whom acute compresion of the vena cava inferior developed after repair of lacerated atrio-caval junction with hemostatic tissue sealant, biologic glue (BioGlue, Cryolife, ınc, Kennesaw, Ga). Removal of the BioGlue relieved the unexpected problem.

Essential thrombocythaemia (ET) is a rare chronic myeloproliferative disease characterised by persistent thrombocytosis. Cerebral, myocardial and peripheral thrombosis are frequently seen complications, but bleeding and venous thrombosis are more rare. Here, a case of essential thrombocythaemia complicated by cerebral and myocardial thrombosis is presented. The patient's platelet count was 680×10(9)/litre on admission. Electrocardiogram showed a slight ST elevation in leads V1 to V4. A coronary angiography was performed and it revealed a severe stenosis of the left anterior descending artery. The patient had a successful off-pump coronary artery bypass grafting surgery. After the operation the platelet count was 390×10(9)/litre. The patient received hydroxyurea and aspirin treatment preoperatively and continued postoperatively. ET is a rare myeloproliferative disease; its complications are also rare, but the occurrence of two life-threatening complications in the same patient is rarer still. Further investigations are needed to determine the risk stratification for patients with ET undergoing cardiac surgery.

Adiponectin functions as an anti-inflammatory and antiatherogenic factor, and the decreased plasma adiponectin is a risk factor for coronary disease. The aim of this study was to determine the changes in plasma levels of adiponectin, a potential parameter for atherosclerosis, in patients underwent surgical revascularization. We included forty patients with atherosclerosis (age, 58 ± 9 years; body mass index [BMI] 26.93 ± 2.3 kg/m 2 ) undergoing coronary artery bypass grafting (CABG). Control group consisted of 40 healthy volunteers, matched for age, gender and BMI (age, 56 ± 6 years; BMI, 26.78 ± 2.3 kg/m 2 ). We measured various parameters, including high sensitive Creactive protein (hsCRP), homeostasis model assessment-insulin resistance (HOMA-IR) indexes, and adiponectin. The baseline profile of the patients before CABG showed higher levels of serum hsCRP (13.15 ± 2.40 mg/l vs 3.97 ± 1.07 mg/l) and HOMA-IR (1.86 ± 0.30 vs 1.26 ± 0.33) and lower plasma adiponectin levels (7.02 ± 2.01 μ g/ml vs 25.46 ± 3.9 μ g/ml), compared to controls ( p < 0.001 for each parameter). Plasma adiponectin level was increased one month after CABG from the baseline level to 8.67 ± 2.05 μ g/ml ( p < 0.001), although the level was still lower than the control value. Thus, postoperative adiponectin level might be helpful for evaluating the progression of atherosclerosis. Moreover, CABG significantly decreased hsCRP to 7.25 ± 1.89 mg/l and HOMA-IR to 1.59 ± 0.33, although these levels were higher than the controls. These results suggest that CABG decreases the cardiac risk factors in atherosclerotic patients.adiponectin; coronary artery bypass grafting; insulin sensitivity; oxidative stress

Microalbuminuria tests should be routinely used as a screening and monitoring tool for the assessment of subsequent cardiovascular morbidity and mortality among hypertensive patients.